Background: There are several risk-stratification tools for cardiac surgery including aortic valve replacement, but similar models are lacking for transcatheter aortic valve replacement (TAVR). Methods: We retrospectively examined the clinical features and course of 45 patients who underwent transcatheter aortic valve replacement (TAVR) with the Edwards-Sapien valve for critical aortic stenosis at our center. All were inoperable for surgical valve replacement. Hospital length of stay (LOS) was calculated from the date of TAVR to the date of discharge and was expressed as mean +/- SD. Pre-operative clinical variables were entered in a Cox-hazard proportional model for LOS. Among these variables, the frailty index was scored with 1 point assigned for each: serum albumin <3.5 mg/dl, in-ability to independently perform at least 4 of 6 Katz activities of daily living, inability to walk 5 meters in less than 7 sec, and grip strength < 18 kg. Patients with > 3 points were considered frail. Results: The mean LOS for all 45 patients was 9.9 +/- 6.9 days. Multivariate predictors of length of stay are illustrated in the table. A total of 22 (49%) were categorized as frail as per our index definition. Mean LOS was 12.1+/-8.4 days among frail patients vs 7.7 +/- 4.0 days among non-frail patients (p=0.029). Conclusions: Our study suggests that frailty is not only a marker for inoperability for surgical aortic valve replacement, but is also predictive of prolonged recovery among patients undergoing transcatheter aortic valve replacement for critical aortic stenosis. This information can be used not only for optimal patient selection but also for counseling patients about realistic post-operative goals and expectations.
Ghatak, A., O’Neill, B., Patel, R., Shah, S., Martinez, C., Moscucci, M., … Alfonso, C. (2012). TCT-875 Frailty is a Major Determinant of Length of Stay After Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology, 60(17), B253. https://doi.org/10.1016/j.jacc.2012.08.921